Provider Demographics
NPI:1780793802
Name:BECK, JEAN S (APRN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:S
Last Name:BECK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 KINGSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3705
Mailing Address - Country:US
Mailing Address - Phone:314-223-0690
Mailing Address - Fax:314-721-7774
Practice Address - Street 1:8149 KINGSBURY BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3705
Practice Address - Country:US
Practice Address - Phone:314-223-0690
Practice Address - Fax:314-721-7774
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO091806363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425032703BEMedicaid